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Can I have a homebirth with a midwife in Alabama?

 

by Stephanie Emfinger, CD(CBI), CCE(AAHCC)

Sadly, no, you can’t have a homebirth with a midwife. Well, you actually can, but it is very complicated…

See, you are free to do what you want and to birth wherever you choose and with whomever you choose. You cannot be prosecuted for birthing at home or elsewhere, and you are not breaking any laws by birthing at home. However, you may be at risk of investigation by the state’s child protective services if someone (like a pediatrician, obstetrician, or family member) “tattles” on your “questionable” or non-mainstream parenting beliefs which “may have” endangered your baby. The outcome of such an investigation into homebirthing parents has currently not been determined.

Although you are free to birth at home, Alabama will not or does not license midwives who practice at out-of-hospital births.  An out-of-hospital midwife attending your homebirth risks facing charges of a class C misdemeanor for “practicing nurse-midwifery without a license”, even if your attendant is not a nurse-midwife at all!

Let me take a few minutes to explain a few things about midwives and Alabama. 

There are several national study programs for a person to learn midwifery and become certified as a midwife--no matter which career background he or she has. Registered nurses can study to become midwives who are called Certified Nurse-Midwives ("CNMs"), and other persons who were not registered nurses can study to become midwives, too.

These non-nurse midwives are also called "direct-entry midwives" because they directly enter the study of midwifery without first learning to become a nurse in a hospital setting, and there are several national certification programs which produce non-nurse midwives. The most recognized type of non-nurse midwife is the Certified Professional Midwife ("CPM"), and the CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital births settings. 

There are also "lay midwives" who have done their own studying and who choose to practice midwifery without being certified. Most doctors and nurses vehemently argue against and block legislation about non-nurse midwives by calling them untrained "lay midwives", even when a CPM is far from untrained! Most healthcare professionals (whether they are aware or ignorant of the differences between lay midwives and types of certified midwives) are currently lobbying against the decriminalization or licensing of midwives produced by nationally recognized and independently accredited certifying organizations by convincing people about how dangerous lay midwifery is. Well, duh. We know that, we agree with you, and we aren't even discussing that. Let's move on already! Geesh! 

According to my research, CNMs practice legally in all 50 states of the USA; non-nurse midwives practice legally in about 34 states and are illegal in 14 states; and CPMs practice legally in 28 states (source and source). 

Since 1976, Alabama does issue licenses to CNMs, although these nurse- midwives must practice in  "the most restrictive environment in the nation according to a 2004 Health and Human Services study" (source). However, Alabama does not license any type of non-nurse midwife, even those midwives who are nationally certified and/or licensed to practice in another state! 

The practice of charging and convicting midwives who aren't licensed CNMs began in 1995 when the Alabama Criminal Court of Appeals overturned a trial court's ruling to dismiss charges against a non-nurse midwife who practiced without a CNM license (source). Alabama voters and the people's state lawmakers never approved or rejected legislation to legalize or to outlaw the practice of non-nurse midwifery, but we are stuck with the court's decision until said voters and their lawmakers can decide otherwise; and I hope you understand how difficult that will be with well-funded lobbying groups such as the Medical Association of the State of Alabama and the Alabama State Nurses Association which are blocking the way to make safer a woman's freedom to birth at home (more information here and here). 

Whew! Are you guys still with me? Let's now get back to how all of this drama and Alabama politicking affect your vagina...

Your options for an out-of-hospital birth are limited to:  traveling to a free-standing birth center in Tennessee, Georgia, or Florida; renting a condo/suite and hiring a homebirth midwife in one of these states; birthing at home with an unlicensed homebirth midwife (who could be charged with a class-C misdemeanor) and risking your pediatrician/obstetrician arrogantly calling Child Protective Services to question your ability to keep and to parent your child(ren); or to train yourself to birth at home without an assistant. None of these options are particularly appealing for most women.

To pursue a natural childbirth in a hospital setting, most mothers prepare themselves by taking childbirth classes, hiring a doula, and finding an obstetrician and a hospital which fit their needs. You might consider doing these steps for yourself, whether or not you decide to birth this way or to pursue other options. Here are a few things to keep in mind:

  1. Look for childbirth classes which are independent of a local hospital! Hospital classes are paid for by the doctors and hospitals they represent, and as such they may not be sharing unbiased, evidence-based information. Many of these classes may be full of information on common interventions and what to expect if [read: “when”] your doctor determines that you “need” them.
  2. Ask potential doulas for references, and then contact those references!  Call, text, or Facebook message these previous clients and ask specific, pointed questions such as:
    • “Did your doula ever speak to your doctor on your behalf, or did she ever make treatment recommendations for your healthcare?” [Red flag! Beware!]
    • “Did your doula support whichever choice you wanted, or did she pressure you one way or another?” [Red flag! Beware!]
    • “Do most doctors in this area recommend your doula’s services or discourage their patients from hiring this doula?” [Consider thoughtfully: If most local doctors (whose outcomes are not what you want) do like this doula, then that could be a bad thing! If most local doctors (whose outcomes are not what you want) do not like this doula, then that could be a could be a good thing! It may not be the doula that they do/n’t like; it may be the doula’s clients! :-). ]
  3. Find an obstetrician and hospital which suit your needs.You can ask for recommendations in Facebook groups for Dothan or Fort Rucker moms, but be sure to screen anyone’s advice based on the type of birth they had. Be wary of any advice from a mother who sings her doctor’s praises and raves about how he “saved my baby’s life!” by intervening in the birth process. However, if you hear the same one or two names and hospitals from mothers who have had birth experiences that you would choose for yourself, then you know you can trust their advice.

I hope this helps, and I understand how frustrating it can be to want better birthing options for our mothers. I was in your same boat 6 years ago while pregnant with my first child. I remember asking my Bradley Method teacher, “Okay, so what I need is a midwife. Who do you recommend?” I was flabbergasted when she responded, “It’s complicated, but most midwives are illegal in Alabama.” That’s what started this whole birth journey of mine…

Further clarification of the history and legality of midwifery can be found in the Alabama Midwives Alliance' position paper regarding the history and legalities of midwifery in Alabama. I would like to thank my esteemed colleague and friend Chloe Raum CPM for her expert review of this article. Thank you, Chloe, for all you do for Alabama mothers and families! :-)

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